Hazardous Drugs

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Possible Solutions

Institutions should have formal written programs to manage hazards. Such programs should include training, exposure assessment, emergency procedures for spills, policies for managing staff with reproductive concerns, and most importantly, ways to ensure that the institution is adhering to critical national standards.

In addition to infrastructure management, employers should address reproductive concerns of employees. Examples that three health care organizations provided to OSHA contain essential elements of a program. Although none of the organizations had a formal written program, they all had processes in place to assure consistency across situations. Importantly, all were deeply familiar with the complexities of work and knew the ONS guidelines and USP 797 (in force at the time) in detail. All three carefully addressed employee concerns for health and safety and were able to consistently implement pay retention, a topic addressed in several formal documents.

Three Examples

Northeast

A healthcare system in a major northeast city with more than five hospitals developed an informal process to address needed restrictions. The concerned employee approaches an employee health clinician with the concern, leading to a conversation and understanding of the degree of hazard, current control strategies, and consequences. When employees wish to be transferred after such events, joint work with human resources and employee occupational health identifies an alternative job without exposures.

Mid-Atlantic

A healthcare system in a mid-Atlantic city with more than five hospitals through trial and error over four years established an informal process of dealing with hazardous drugs to assure adequate assessment, communication, and employee satisfaction. Three steps appeared essential.

When an employee expresses concerns over the possibility of adverse reproductive outcomes, the employee health unit discusses content with safety, and a safety manager / industrial hygienist conducts a site visit to ensure that all systems are working and meet relevant standards. This includes a review of work practices.

A conversation with the employee identifies the specific concerns and generates an interactive process to identify reasonable work location, duration, and responsibilities. Those discussions are managed under a joint occupational health and human resources umbrella.

The patient is reassigned with pay retention.

All employees at this healthcare system could be accommodated using a broad range of accomodations. One employee, a lab researcher conducting animal research with hazardous drugs, was simply restricted from working with drugs with known reproductive toxicity during her pregnancy and breast feeding time.

Northwest

A major hospital reviewed the Washington State law, identified timelines, made a plan, and initiated training for hazardous drugs for nurses and pharmacists, as required. The safety office has developed plans using the risk assessment tools and guidance but not yet used them formally since staff are still accommodated informally.

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